on Glycemic Control in Patients With Type 2 Diabetes The Glycemic Optimization with Algorithms and Labs at Point of Care

OBJECTIVE — The objective of this study was to assess the impact of active versus usual monitoring of algorithmic insulin titration and point-of-care (POC) versus laboratory HbA1c (A1C) measurement on glycemic control in primary care. RESEARCH DESIGN AND METHODS — The Glycemic Optimization with Algo-rithms and Labs at Point of Care (GOAL A1C) study was a 24-week, randomized, parallel-group, four-arm, open-label study of 7,893 adults with type 2 diabetes uncontrolled by oral antidiabetic agents and requiring insulin. Patients were randomly assigned by investigators from 2,164 sites in the U.S. to insulin glargine with either 1) usual (no unsolicited contact between visits) insulin titration using a simple algorithm with laboratory A1C testing, 2) usual titration with POC A1C testing, 3) active (weekly monitored) titration with laboratory A1C testing, or 4) active titration with POC A1C testing. Outcome measures included a change in A1C and fasting self-monitoring of blood glucose (SMBG) levels, percentage of patients achieving A1C7.0%, and hypoglycemia frequency. RESULTS — Significant A1C and SMBG reductions were observed in all arms (P 0.0001). Compared with usual insulin titration, active titration achieved greater A1C reduction (1.5 vs